How important are old ECGs in Non-obvious cases of potential OMI?

Conclusion: As per Dr. Smith — the cath lab was initially activated on the basis of the history of changing symptoms occurring in association with dynamic ST-T wave changes on these 3 serial ECGs shown in Figure-1.BUT — Review of this patient ' s medical chart revealed previous ECGs showing a similar pattern of labile ECG changes. Some patients do this ... that is, show a pattern of labile ST-T wave changes not due to an acute coronary event.Despite the seemingly worrisome ST-T wave changes on serial tracings shown in Figure-1  — an acute event was definitively ruled out by 4 consecutive negative hs troponins — with further support provided by an Echo showing excellent LV function without wall motion abnormality.Echo did show " moderately increased wall thickness " — so LVH is presumably playing a role in the changing ST-T wave appearance seen on this and previous hospital admissions(albeit the ST-T wave changes that we see arenot those expected simply from LVH).FINAL Thought: Looking at the ECG changes seen in the 3 serial tracings shown in Figure-1, in association with the changing severity of this patient ' s symptoms — I completely agree with the initial decision to activate the cath lab. That said — following review of this patient ' s chart (that revealed a similar pattern of labile ST-T wave changes on previous admissions)+ 4 consecutive negative hs troponin values — an acut...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs